Browsing by Author "Pimentel, Fernando"
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- ItemDisruptive behavior in the operating room: Systemic over individual determinants(ELSEVIER SCI LTD, 2022) Campos, Mauricio; Lira, Maria Jesus; Mery, Pamela; Calderon, Maribel; Sepulveda, Macarena; Pimentel, Fernando; Zuniga, DenisseBackground: The operating room (OR) environment presents specific conditions that put stress on work dynamics. Disruptive behavior among members of the health team is recognized to affect work dynamics and patient outcomes. As surgeons have been syndicated as frequent disruptors, the objective was to explore their perceptions about OR working dynamics and the occurrence of disruptive behavior. Study design: Qualitative exploratory study, based on semi-structured individual interviews. Twenty participants were sampled until data saturation. For better context, we also included in the sample anesthesiologists, nurses, and technicians, among others. Using grounded theory framework, investigators extracted data from verbatim transcriptions with qualitative software. Results: Problems of infrastructure, interpersonal relationships, and organizational failures had most density of citations and trigger the most disruptive behavior narrated events. Although personality traits were noted to promote some disruptive behavior occurrence, systemic determinants were critical, such as poorly defined working roles and a plethora of personal ways to cope or avoid disruptive behavior. Conclusion: Our results suggest that disruptive behavior events are not just a matter of a surgeon's personality traits but also substantiated by systemic normalization, informal communication strategies, and undefined roles, making teams less resilient to unexpected events.
- ItemGenetic evidence that apolipoprotein E4 is not a relevant susceptibility factor for cholelithiasis in two high-risk populations(AMER SOC BIOCHEMISTRY MOLECULAR BIOLOGY INC, 2007) Mella, Juan G.; Schirin Sokhan, Ramin; Rigotti, Attilio; Pimentel, Fernando; Villarroel, Luis; Wasmuth, Hermann E.; Sauerbruch, Tilman; Nervi, Flavio; Lammert, Frank; Miquel, Juan FranciscoApolipoprotein E (apoE) isoforms are genetic determinants of interindividual variations in lipid metabolism. To assess whether apoE is a genetic risk factor for cholesterol gallstone disease (GD), we analyzed apoE variants in populations from Chile and Germany, two countries with very high prevalence rates of this disease. ApoE genotypes were determined in Chilean gallstone patients (n = 117) and control subjects (n = 122) as well as in German gallstone patients ( n 5 184) and matched controls (n = 184). In addition, we studied apoE variants in subgroups of Chilean patients with strong differences in their susceptibility to acquire gallstones: 50 elderly subjects without gallstones in spite of well-known risk factors for this disease (gallstone-resistant) and 32 young individuals with gallstones but without risk factors (gallstone-susceptible). Furthermore, correlation analysis of apoE genotypes with cholesterol crystal formation times, biliary cholesterol saturation index (CSI), and gallstone cholesterol contents was performed in 81 cholecystectomized patients. In this study analyzing the largest sample set available, apoE4 genotype was not associated with an increased frequency of GD in either population. Moreover, in the Chilean population after adjusting for risk factors such as gender, age, body mass index, serum lipids, and glucose, the odds ratio for the association of the apoE4 allele and GD was significantly (P < 0.05) < 1. Also, genotypes were not correlated with cholesterol crystal formation time, CSI, or gallstone cholesterol content. In contrast to previous smaller studies, apoE polymorphisms were not associated with susceptibility to cholesterol GD in high-risk populations.
- ItemLaparoscopic Sleeve Gastrectomy as a Stand-Alone Procedure for Morbid Obesity: Report of 1,000 Cases and 3-Year Follow-Up(SPRINGER, 2012) Boza, Camilo; Salinas, Jose; Salgado, Napoleon; Perez, Gustavo; Raddatz, Alejandro; Funke, Ricardo; Pimentel, Fernando; Ibanez, LuisLaparoscopic sleeve gastrectomy (LSG) is an emerging surgical technique with encouraging results. The objective of this study is to report surgical results after 1,000 consecutive LSG cases as a stand-alone procedure for morbid obesity during a 3-year follow-up.
- ItemPhytosterol and cholesterol precursor levels indicate increased cholesterol excretion and biosynthesis in gallstone disease(WILEY-BLACKWELL, 2012) Krawczyk, Marcin; Luetjohann, Dieter; Schirin Sokhan, Ramin; Villarroel, Luis; Nervi, Flavio; Pimentel, Fernando; Lammert, Frank; Francisco Miquel, JuanIn hepatocytes and enterocytes sterol uptake and secretion is mediated by Niemann-Pick C1-like 1 (NPC1L1) and ATP-binding cassette (ABC)G5/8 proteins, respectively. Whereas serum levels of phytosterols represent surrogate markers for intestinal cholesterol absorption, cholesterol precursors reflect cholesterol biosynthesis. Here we compare serum and biliary sterol levels in ethnically different populations of patients with gallstone disease (GSD) and stone-free controls to identify differences in cholesterol transport and synthesis between these groups. In this case-control study four cohorts were analyzed: 112 German patients with GSD and 152 controls; two distinct Chilean ethnic groups: Hispanics (100 GSD, 100 controls), and Amerindians (20 GSD, 20 controls); additionally an 8-year follow-up of 70 Hispanics was performed. Serum sterols were measured by gas chromatography / mass spectrometry. Gallbladder bile sterol levels were analyzed in cholesterol GSD and controls. Common ABCG5/8 variants were genotyped. Comparison of serum sterols showed lower levels of phytosterols and higher levels of cholesterol precursors in GSD patients than in controls. The ratios of phytosterols to cholesterol precursors were lower in GSD patients, whereas biliary phytosterol and cholesterol concentrations were elevated as compared with controls. In the follow-up study, serum phytosterol levels were significantly lower even before GSD was detectable by ultrasound. An ethnic gradient in the ratios of phytosterols to cholesterol precursors was apparent (Germans > Hispanics > Amerindians). ABCG5/8 variants did not fully explain the sterol metabolic trait of GSD in any of the cohorts. Conclusion: Individuals predisposed to GSD display increased biliary output of cholesterol in the setting of relatively low intestinal cholesterol absorption, indicating enhanced whole-body sterol clearance. This metabolic trait precedes gallstone formation and is a feature of ethnic groups at higher risk of cholesterol GSD. (HEPATOLOGY 2012)
- ItemSplenic rupture following colonoscopy(BAISHIDENG PUBLISHING GROUP INC, 2008) Francisco Guerra, Juan; San Francisco, Ignacio; Pimentel, Fernando; Ibanez, LuisColonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insufflation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy. (C) 2008 The WJG Press. All rights reserved.
- ItemWeight Loss and Metabolic Improvement in Morbidly Obese Subjects Implanted for 1 Year With an Endoscopic Duodenal-Jejunal Bypass Liner(LIPPINCOTT WILLIAMS & WILKINS, 2012) Escalona, Alex; Pimentel, Fernando; Sharp, Allan; Becerra, Pablo; Slako, Milenko; Turiel, Dannae; Munoz, Rodrigo; Bambs, Claudia; Guzman, Sergio; Ibanez, Luis; Gersin, KeithObjective: To evaluate safety, weight loss, and cardiometabolic changes in obese subjects implanted with the duodenal-jejunal bypass liner (DJBL) for 1 year.